Hepatitis C ‘18+’ Testing is Cost Effective
Expanded Hepatitis C testing strategies would identify more cases, cure more people
As the rate of infection with Hepatitis C virus soars in the United States, clinicians are seeking new, innovative solutions to resolve this outbreak.
Over just 5 years, the number of new hepatitis C virus (HCV) infections has nearly doubled, according to data from the Centers for Disease Control and Prevention (CDC).
The increase is driven by people who inject drugs (PWID), the CDC says.
But a clear majority of HCV cases are still diagnosed in baby boomers, who are six times more likely to be infected with HCV than people in other age groups.
Baby-Boomers make up about 75% of all HCV cases in the U.S.
Newly published research suggests that expanding one-time Hepatitis C virus testing to everyone over 18 years of age would be cost-effective, and improve clinical outcomes.
This study reported the greatest results were observed in the “18+ Strategy”, with an estimated 256,000 additional infected persons identified.
Additionally, the ‘18+ Strategy’ would deliver the lowest cost per quality-adjusted life year, at $28,000.
The current CDC and the U.S. Preventive Services Task Force recommend a one-time HCV test for persons born between 1945-1965, with additional testing for ‘high-risk’ persons.
To estimate the HCV screening cost-effectiveness, researchers at Massachusetts General Hospital and Harvard University Medical School used a simulation model called the Hepatitis C Cost-Effectiveness (HEP-CE).
They applied the HEP-CE model to each of four HCV screening options:
- The standard of care: one-time testing of everyone born between 1945 and 1965;
- ≥40 strategy: one-time testing of everyone aged 40 years or older;
- ≥30 strategy: one-time testing of everyone aged 30 years or older; and
- ≥18 strategy: one-time testing of everyone aged 18 years or older.
These researchers reported that each of the expanded testing strategies would identify more HCV cases, and would cure more patients than the CDC’s current guidelines.
Hepatitis C is a liver infection caused by the HCV, a blood-borne virus.
Most people today become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. For some people, hepatitis C is a short-term illness but for 70%–85% of people who become infected with Hepatitis C, it becomes a long-term, chronic infection.
Because hepatitis C has few symptoms, nearly half of people living with the virus don’t know they are infected and the vast majority of new infections go undiagnosed.
Hepatitis C kills more Americans than any other infectious disease reported to CDC.
“By testing, curing, and preventing hepatitis C, we can protect generations of Americans from needless suffering and death,” said Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
“We must reach the hardest-hit communities with a range of prevention and treatment services that can diagnose people with hepatitis C and link them to treatment.”
Another study, published in the CDC’s Morbidity and Mortality Weekly Report, examines the range of state laws that can influence access to treatment for hepatitis C.
This study finds that the laws governing access to comprehensive HCV prevention services varied in the 17 states with high HCV incidence in 2015.
For example among the three states with the highest HCV incidence rates (Kentucky, Massachusetts, and West Virginia), West Virginia had less comprehensive laws, and Kentucky and Massachusetts had more comprehensive laws.
However, some of these laws did not take effect until 2015, suggesting that some laws might have been enacted in response to the increased HCV prevalence in these states.
While new medicines can now cure hepatitis C virus infections in as little as two to three months, many people in need of treatment are still not able to get it.
The CDC released the National Viral Hepatitis Action Plan, 2017-2020 that sets goals for improving prevention, care, and treatment of viral hepatitis and puts the nation on a course toward eliminating new hepatitis infections.
There is not a Hepatitis C vaccine available.
These researchers did not disclose any conflicts of interest: Joshua A Barocas, MD Abriana Tasillo Golnaz Eftekhari Yazdi, MScJianing Wang, MSc Claudia Vellozzi, MD, MPH Susan Hariri, PhDCheryl Isenhour, DVM, MPH Liisa Randall, PhD John W Ward, MD, Jonathan Mermin, MD, MPH, Joshua A Salomon, PhD Benjamin P Linas, MD, MPH.
- Viral Hepatitis
- Population level outcomes and cost-effectiveness of expanding the recommendation for age-based hepatitis C testing in the United
- The Impact of Enhanced Screening and Treatment on Hepatitis C in the United States
- Enhancing Assessment and Treatment of Hepatitis C in the Custodial Setting
- New Hepatitis C Infections Nearly Tripled over Five Years
- Expanding Hepatitis C testing to all adults is cost-effective and improves outcomes